title: Racial differences in antilipemic use and lipid control in high-risk older adults: post-Medicare Part D.
abstract: BACKGROUND
  Older blacks are less likely to receive guideline-recommended antilipemic therapy and achieve lipid control than older whites because, in part, of out-of-pocket costs. We sought to determine whether racial differences in antilipemic use and lipid control narrowed after Medicare Part D's implementation.
  
  
  METHODS
  This before-after study included 1,091 black and white adults 70 years or older with coronary heart disease and/or diabetes mellitus from the Health Aging and Body Composition Study. Primary outcomes were antilipemic use and low-density lipoprotein cholesterol control. Key independent variables were race, time (pre-Part D vs post-Part D), and their interaction.
  
  
  RESULTS
  Before Part D, fewer blacks than whites reported taking an antilipemic (32.70% vs 49.35%), and this difference was sustained after Part D (blacks 48.30% vs whites 64.57%). Multivariable generalized estimating equations confirmed no post-Part D change in racial differences in antilipemic use (adjusted ratio of the odds ratio 1.07, 95% CI 0.79-1.45). Compared with whites, more blacks had poor lipid control both before Part D (24.30% vs 12.36%, respectively) and after Part D (24.46% vs 13.72%, respectively), with no post-Part D change in racial differences in lipid control (adjusted ratio of the odds ratio 0.82, 95% CI 0.51-1.33).
  
  
  CONCLUSIONS
  Although antilipemic use increased after Medicare Part D for both races, this policy change was associated with a change neither in lipid control for either racial group nor in the racial differences in antilipemic use or lipid control.
authors.affiliation: Department of Medicine (Geriatrics), University of Pittsburgh, Pittsburgh, PA. Electronic address: jth14@pitt.edu.
authors.forename: Joseph T
authors.initials: JT
authors.lastname: Hanlon
authors.forename: Robert M
authors.initials: RM
authors.lastname: Boudreau
authors.forename: Subashan
authors.initials: S
authors.lastname: Perera
authors.forename: Elsa S
authors.initials: ES
authors.lastname: Strotmeyer
authors.forename: Anne B
authors.initials: AB
authors.lastname: Newman
authors.forename: Eleanor M
authors.initials: EM
authors.lastname: Simonsick
authors.forename: Ronald I
authors.initials: RI
authors.lastname: Shorr
authors.forename: Douglas C
authors.initials: DC
authors.lastname: Bauer
authors.forename: Julie M
authors.initials: JM
authors.lastname: Donohue
mesh_terms: D001741:Black or African American; D000368:Aged; D003327:Coronary Disease / Q000097:blood / Q000188:drug therapy* / Q000191:economics; D016527:Drug Costs; D006801:Humans; D000960:Hypolipidemic Agents / Q000191:economics* / Q000627:therapeutic use; D008055:Lipids / Q000097:blood*; D054524:Medicare Part D / Q000191:economics*; D014481:United States; D044465:White People
chemical_list: D000960:Hypolipidemic Agents; D008055:Lipids